Physicians' attitudes at the end-of-life: a cross-cultural evaluation.

Physician's attitudes towards patients with incurable cancer or at the end-of-life process--treatment of patients, withholding ventilation support, physician-assisted suicide--have changed rapidly in recent years. In cases such as incurable cancer, illnesses in the terminal phase, some neurologic diseases and AIDS, physicians and other health care workers experience dilemmas, arguments and problems on the subjects of whether or not to tell the truth or how to do it, who should inform the patient or his/her guardian, and then, how to give treatment to patients with incurable cancer or withhold ventilation support. All of these issues are affected by the country's' sociocultural and economic structures, the physician's attitudes at the end of life,the medical practice and the form of health structures. In this study our objectives are to assess physicians' views in Turkey regarding the process of the end of life and decision-making, to compare them with views from the USA, Japan and Saudi Arabia and to cristalize a cross-cultural assessment. Our study contains three clinical situations covering the following areas: (1) a patient's right to be informed of incurable cancer, (2) doctor-assisted suicide (3) the conflicting rights of patients, doctors and the family in issues such as refusing ventilatory support or witholding treatment. The four-point Likert Scale was used to mark the responses to the statements. The significant cultural, social and economic differences that exist in health care services between regions in our country affect physician-patient communication and end of life decision-making, as reflected in the process of obtaining informed consent.